‘Business as unusual’ for hygiene and sanitation

Poor handwashing behaviours and lack of access to clean, safe toilets have a profound impact on the lives and potential of children in developing countries. For Global Handwashing Day and World Toilet Day, we asked Professor Val Curtis from the London School of Hygiene & Tropical Medicine how and why businesses should tackle this issue.

Professor Val Curtis

Director of the Environmental Health Group at the London School of Hygiene & Tropical Medicine

Val is a behavioural scientist who co-created Behaviour Centred Design, a new evolutionary approach to behaviour change. She helped to found the Global Public–Private Partnership for Handwashing with Soap and the Toilet Board Coalition.

Val researches, teaches and consults on behaviour change and water, sanitation and hygiene with governments, international organisations and industry. She is behavioural adviser to the Clean India Campaign (Swachh Bharat Abhiyan), to the Tanzanian government’s sanitation programme and to Lifebuoy’s global handwashing programmes. She has been published widely on hygiene, behaviour and disgust.

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We’ve learnt that only some 17% of people worldwide wash their hands with soap at key moments, like after the toilet, and that this figure is much lower in low-income countries. A third of the world’s population do not have a toilet.

This means that the majority of the world’s population are at high risk of diseases that are transmitted via the faecal–oral route. This is where microbes contained in faeces get onto hands and into the environment, and from there hop a lift on flies and fingers into food and water, and then into children. This causes debilitation and death from diarrhoea and worm infections and has knock-on effects on their nutrition, growth and development.

From awareness to action

So it’s a huge problem, one that many different organisations, governments, international bodies and those working in industry have been trying to tackle.

The first step we’ve taken is to raise awareness of the problem. We’ve got governments globally to sign up to the Sustainable Development Goals (SDGs) which commit them to organising universal access to sanitation and better hygiene. Almost everybody you meet – in any walk of life, in any country – can tell you why toilets and handwashing are important. Sadly, the knowledge hasn’t always been matched with practice.

Mass campaigns are needed to change behaviour. India is a great beacon of hope, with a huge national effort to encourage everyone to build and use a toilet. Led from the top, by the Prime Minister Narendra Modi, it reaches down to almost every one of India’s estimated 640,000 villages. As a result, toilet coverage has gone from 40% to 70% in the last three years. Handwashing is improving too, but not at such a fast rate.

As countries develop and individuals get richer, those who escape from poverty are opting for modern lifestyles. They want better toilets, running water and all of the products that go with these changes. Governments cannot avoid their responsibility to plan for development, particularly in urban areas, but the infrastructure and systems required are nowhere near keeping pace with population growth.

The role of industry

And here’s where industry has a major role to play. Those people moving on up are the consumers of the future. They will want the full range of modern products that those of us living in rich countries take for granted. But industry is not doing enough to tap into these new markets, nor are they doing enough to innovate to find the solutions that are needed.

Much of Tanzania, a newly industrialising country, looks like a building site, with house improvement going on at a phenomenal rate. Companies with bathroom products to sell would do well to get into this boom early, as should companies that manufacture soap, etc. The result will be a win-win. More soap and toilet products will be sold, more economic activity will help to stabilise risky markets, more people will get richer, more will stay healthy, and the virtuous cycle will continue.

Thinking differently about partnerships

But this requires a ‘business as unusual’ approach – we need to think differently about these partnerships for development.

Industry needs to partner with health professionals who can guide them towards the most urgent problems. And they need to be able to use the latest behavioural science and design tools to imagine new solutions, starting from where the problem is: in communities.

We know it is no good inventing a fantastic new product if it is not what the consumer wants, or if there is no viable business model. Companies need to take a longer view of innovation in developing markets if they want to share in this huge future growth. And business needs to tell the story of the good that they are doing, so that trusting partnerships between all players with an interest in ending poverty and improving public health can be created.

Industry trailblazers

LIXIL is a global leader in sanitary ware and water technology. It’s also a great example of a business making a difference in this area. It believes that access to safe and hygienic sanitation practices should be available to everyone and it has pledged to provide better sanitation to 100 million people by 2020. I’m very excited to see that LIXIL is starting to widely market simple and cheap products that can be used to improve the toilets of rural people in Africa.

Unilever, too, has been a trailblazer. The toilet cleaning brand, Domestos has recently collated a source book of best practices entitled More Toilets Used by More People (PDF | 11MB), which shares consumer insights that can help us drive behaviour change.

And Lifebuoy soap has one of the largest handwashing behaviour-change programmes. By applying its insights to consumer behaviour change and marketing, the brand empowers mothers and school-aged children to make a habit of handwashing with soap at key occasions. While Lifebuoy still has a way to go before it reaches its target to get messages about handwashing to a billion people by 2020, it is a great example of a win-win between the public and the private sector.